Thought leaders from several disciplines recently gathered at the Stanford campus for the inaugural ChildX conference to discuss how to solve health problems in pregnancy, infancy and childhood. One session focused on the future of child health in an aging America and featured Stanford health policy expert and CHP/PCOR faculty Paul Wise, who discussed the evaporation of child health policy in the U.S.

In this podcast, he talks about how health policy has turned into cost-containment policy, spelling trouble for children and child health. 

Wise also addressed the conference on the future of child health policy in the United States.

Stanford Law Professors Rob MacCoun and Michelle Mello say that marijuana edibles, which look like snacks and are often highly potent, should be better regulated in an effort to protect young children.

States that have legalized marijuana need to put strong restrictions on the drug's edible products, according to two Stanford law professors.

In a new article in the New England Journal of Medicine, Robert MacCoun and Michelle Mello of Stanford Law School wrote that one of the most notable features of the rollout of state-legalized retail sales of marijuana has been the tremendous popularity of edible products.

The problem is that marijuana edibles – which often look like candy or cookies and are frequently potent – increase the chances that children will overdose, they wrote in the article. MacCoun studies social psychology, and Mello, health policy.

"As legalization of marijuana spreads, new adopters (states) should ensure that their regulatory scheme for marijuana edibles is fully baked," wrote Mello and MacCoun, who is a senior fellow at Stanford's Freeman Spogli Institute for International Studies.

Marijuana use for adults over 21 is fully legal in Colorado, Washington and Alaska. Oregon passed a similar law that will take effect in July. Several other states have legalized marijuana for medicinal use or have decriminalized it. A notable feature of state-legalized retail sales of marijuana has been the popularity of edibles.

Attractive nuisance

In an interview, MacCoun explained that the original marijuana laws were based on ballot initiatives, without legislative give-and-take processes. "As a result, they were not rigorous and detailed in their approach to issues like edibles," he said

Colorado and Washington put extremely modest rules on edibles, therefore making it easy to sell and market edible products, he said.

"Both states require child-resistant packaging, a warning to 'keep out of the reach of children,' and labeling describing a standard serving size. Neither requires warnings that ingested marijuana can have different effects from smoked marijuana," wrote MacCoun and Mello.

While both Colorado and Washington generally prohibit packaging and advertising that targets children, neither state requires packaging that would clearly distinguish edibles from ordinary food products, MacCoun said. Some of the edibles look like Hershey or KitKat bars, and the drinks resemble the major brands of non-marijuana colas.

Mello said the issue brings to mind the tort-law concept of an "attractive nuisance," which describes a hazardous condition that is likely to attract children who are unable to appreciate the risk involved.

"It also evokes tobacco companies' use of advertising campaigns with youth appeal," MacCoun and Mello wrote.

They acknowledge that marijuana is associated with a long history of "public misinformation" about the effects of the drug. But the scientific record is clear on the documented risk of edibles, especially for children. "Some of these products contain four or more times the level of tetrahydrocannabinol (THC) that is considered to be a safe dose," they noted.

Taken in large doses, THC can produce serious anxiety attacks and psychotic-like symptoms, according to MacCoun and Mello. Strong differences exist in the pharmacokinetic and metabolic effects of marijuana when it is ingested rather than smoked.

Case reports document respiratory insufficiency in young children who have ingested marijuana through edibles, MacCoun said. A recent study showed that the proportion of ingestion-related emergency department visits by children in Colorado associated with marijuana ingestion increased after legal restrictions were eased. The majority of identified sources in those cases were marijuana edibles.

Other factors are important to consider as well. "The availability of child-friendly edibles could increase the probability of initiation to marijuana use, reduce the average age of initiation, and increase the frequency and intensity of use among users of all ages," according to MacCoun and Mello.

States, not feds, have the power

States have created a wide berth for marketing of marijuana edibles that federal agencies are unwilling or unable to narrow, MacCoun and Mello said. That is why they can enact stronger, more effective regulations on the formulation, packaging and marketing of edible marijuana products. And it is best to do this when those laws are being written, either at the ballot or in legislative chambers – not later on.

"We're advocating some fairly modest regulations that would not restrict the ability of adults to use marijuana," MacCoun said.

MacCoun and Mello wrote that child-resistant packaging is necessary but not sufficient – "Older children can easily defeat it." They suggested the following measures:

• Clear labeling and standardization of THC doses and recommended serving sizes
• Warning labels about the risks that edible marijuana poses for overintoxication
• Regulations to ensure that edibles do not look like familiar non-marijuana sweets

Also, the courts may serve as another avenue of regulation, as well as food companies that perceive trademark infringement issues with the edibles. The authors know of at least one such lawsuit already under way, with additional ones on the way.

The federal government does not regulate marijuana edibles, or marijuana at all, they wrote. As a Schedule I controlled substance – which means it has a high potential for abuse – marijuana is not recognized by the federal government for sales or usage.

This is why it is up to the states. "Once you legalize it, you can regulate it," MacCoun said.

Rob MacCoun is interviewed in this video by Stanford Law magazine about the challenges of marijuana legalization.

Media Contact

Robert MacCoun, Stanford Law School: , maccoun@law.stanford.edu

Michelle Mello, Stanford Law School: , mmello@law.stanford.edu

Clifton B. Parker, Stanford News Service: , cbparker@stanford.edu

Paul Kalanithi wrote essays for The New York Times and Stanford Medicine reflecting on being a physician and a patient, the human experience of facing death, and the joy he found despite terminal illness. The Stanford neurosurgeon died of lung cancer March 9. He was 37.

Pregnant women with a recent diagnosis of post-traumatic stress disorder were 35 percent more likely to deliver a premature baby than were other pregnant women, a study of more than 16,000 births found.

Michael McFaul, a Stanford political scientist and former U.S. ambassador to Russia, has been selected as the next director of the university’s Freeman Spogli Institute for International Studies.

The announcement was made Wednesday by Stanford Provost John Etchemendy and Ann Arvin, the university’s vice provost and dean of research. McFaul will succeed Mariano-Florentino Cuéllar, who was nominated in July as an associate justice of the California Supreme Court and elected Tuesday.

McFaul takes the helm of FSI in January.

"Stanford has long been a home for scholars who connect academia to policy and public service, and Professor McFaul is the embodiment of that model," Etchemendy said. "We are grateful for Mike's service and confident he will be a strong leader for FSI."

Arvin said McFaul is a strong fit for the position.

“Professor McFaul’s background as an outstanding scholar and his service as an influential ambassador give him a vital perspective to lead FSI, which is Stanford’s hub for studying and understanding international policy issues,” she said. “His scholarship, experience and energy will keep FSI and Stanford at the forefront of international studies as well as some of the most pressing global policy debates."

McFaul has been a faculty member in the department of political science at Stanford since 1994.  He joined the Obama administration in January 2009, serving for three years as Special Assistant to the President and Senior Director for Russian and Eurasian Affairs at the National Security Council at the White House. He then served as U.S. Ambassador to the Russian Federation from 2012 to 2014.

McFaul already has a deep affiliation with FSI. Before joining the government, he served as FSI deputy director from 2006 to 2009.  He also directed FSI’s Center on Democracy, Development, and the Rule of Law (CDDRL) from 2005 to 2009.

During his four years leading CDDRL, McFaul launched the Draper Hills Summer Fellowship program for mid-career lawyers, politicians, advocates and business leaders working to shore up democratic institutions in their home countries. He also established CDDRL’s senior honors program.  From 1992-1994, McFaul also worked as a Senior Research Fellow at FSI’s Center for International Security and Cooperation (CISAC).

“I am thrilled to be assuming a leadership role again at FSI,” McFaul said.  “FSI has become one of the premier institutions in the country for policy-relevant research on international affairs.  I look forward to using my recent government experience to deepen further FSI’s impact on policy debates in Washington and around the world.”

Arvin said McFaul’s previous positions at FSI and CDDRL will make for a smooth transition in the institute’s leadership.

“His familiarity with FSI’s history and infrastructure will allow him to start this new position with an immediate focus on the institute’s academic mission,” she said.

McFaul is also the Peter and Helen Bing Senior Fellow at the Hoover Institution, and plans to build on his long affiliations with both Hoover and FSI to deepen cooperation between these two premier public policy institutions on campus.

He has written and co-authored dozens of books including Advancing Democracy Abroad: Why We Should, How We Can; Transitions To Democracy: A Comparative Perspective (with Kathryn Stoner); Power and Purpose: American Policy toward Russia after the Cold War (with James Goldgeier); and Russia’s Unfinished Revolution: Political Change from Gorbachev to Putin.

“In so many ways, Mike represents the best of FSI,” said Cuéllar, who has held leadership positions at FSI since 2004 and begins his term on the California Supreme Court in January. “He knows the worlds of academia and policy extremely well, and will bring unique experience and sound judgment to his new role at FSI.”

McFaul currently serves as a news analyst for NBC News, appearing frequently on NBC, MSNBC, and CNBC as a commentator on international affairs. He also appears frequently on The Charlie Rose Show and The Newshour, as well as PBS and BBC radio programs. He has recently published essays in Foreign Affairs, The New York Times, Politico, and Time. 

McFaul was one of the first U.S. ambassadors to actively use social media for public diplomacy. He still maintains an active presence on Facebook at amb.mcfaul and on Twitter at @McFaul.

McFaul received his B.A. in International Relations and Slavic Languages and his M.A. in Russian and East European Studies from Stanford University in 1986.  As a Rhodes Scholar, he completed his D. Phil. in International Relations at Oxford University in 1991.

“Since coming here in 1981 as 17-year-old kid from Montana, Stanford has provided me with tremendous opportunities to grow as a student, scholar, and policymaker,” McFaul said. “I now look forward to giving back to Stanford by contributing to the development of one of the most vital and innovative institutions on campus.” 

Paul Wise discusses the effects of the Affordable Care Act on children's health care.

Fourteen Stanford researchers addressing global poverty through a range of academic disciplines are receiving a total of $4.6 million in awards from the university-wide Global Development and Poverty (GDP) initiative.

Their projects, which are the first to be funded by the GDP, deal with challenges of health, violence, economics, governance and education in the developing world.

“GDP seeks to transform scholarly activity and dialogue at Stanford around the topic of global poverty, so that the university may have a greater impact on poverty alleviation in developing economies,” said GDP faculty co-chair Jesper B. Sørensen. “By focusing on placing a small number of big bets, GDP encourages researchers to think big, and to move beyond the conventional way of doing things. We are thrilled by the inaugural set of awardees, as they demonstrate the creative, inter-disciplinary approaches that will make Stanford a leader in this area.”

The GDP initiative is part of the Stanford Institute for Innovation in Developing Economies (SEED) and is administered in partnership with Stanford's Freeman Spogli Institute for International Studies (FSI). The GDP is co-chaired by Sørensen, the faculty director for SEED and the Robert A. and Elizabeth R. Jeffe Professor of Organizational Behavior at the Graduate School of Business; and Mariano-Florentino Cuéllar, senior fellow and director of FSI and the Stanley Morrison Professor at Stanford Law School.

SEED, which seeks to alleviate poverty by stimulating the creation of economic opportunities through innovation, entrepreneurship and the growth of businesses, was established in 2011 through a generous gift from Robert King, MBA '60, and his wife, Dorothy.

Through complementary areas of focus, GDP funding and other SEED research initiatives will stimulate research, novel interdisciplinary collaborations and solutions to problems of global poverty and development. GDP research aims to pursue answers to crucial questions that are essential to an understanding of how to reduce global poverty and promote economic development. That includes governance and the rule of law, education, health, and food security – all of which are essential for entrepreneurship to thrive. By contrast, other SEED research focuses on innovation, entrepreneurship, and the growth of businesses in developing economies.

Since 2012, SEED’s Entrepreneurship and Innovation in Developing Economies Award program also has doled out 22 awards and seven PhD fellowships to help support and scale businesses in developing economies. Among the $1 million in funded projects were studies of how to improve the livelihoods of small-holder cacao farmers throughout the tropics; how to identify startups with high job- and wealth-creating potential in Chile; how political accountability affects the ability to attract investment in Sierra Leone; and how managerial practices affect trade entrepreneurship in China.

First GDP Awards

The first 14 GDP award recipients are professors of economics, political science, law, medicine, pediatrics, education and biology, and senior fellows from FSI, the Woods Institute, and the Stanford Institute for Economic Policy Research (SIEPR).

“Each of these projects cuts across disciplines, reflects innovative thinking, and has the potential to generate crucial knowledge about how to improve the lives of the poor around the world,” Cuéllar said. “These projects, along with a variety of workshops engaging the university and external stakeholders, will help us strengthen Stanford’s long-term capacity to address issues of global poverty through research, education and outreach.”

Among the award recipients is Pascaline Dupas, an associate professor of economics and senior fellow at SIEPR. Dupas, along with faculty from the Center for Health Policy and Center on Democracy, Development and the Rule of Law, will launch the Stanford Economic Development Research Initiative using GDP funds.  This initiative will focus on collecting high-quality institutional and individual-level data on economic activity in a number of developing countries over the long term, and making these data available to scholars around the world.

Beatriz Magaloni, an associate professor of political science and senior fellow at FSI, is receiving an award to lead a team focused on criminal violence and its effects on the poor in developing economies, and the practical solutions for increasing security in those regions.

Douglas K. Owens, a professor of medicine and FSI senior fellow, was awarded an award to help him lead a team that will develop models to estimate how alternative resource allocations for health interventions among the poor will influence health and economic outcomes.

Stephen Haber, a professor of political science and history and a senior fellow at the Hoover Institution, received an award to bring together Stanford researchers interested in examining the long-term institutional constraints on economic development. Their goal will be to provide policymakers with a framework for determining the conditions under which particular innovations are likely to have positive payoffs, and the conditions under which resources will likely be wasted.

Other projects will address the educational impacts of solar lighting systems in poor communities; identifying interventions to improve the profits and safety among poor, smallholder pig farmers in Bangladesh and China; the role of law and institutions in economic development and poverty reduction; and how to rethink worldwide refugee problems. Awards are also being provided to researchers focused on microfinance, online education and teacher training.

The project proposals were reviewed by an interdisciplinary faculty advisory council chaired by Cuéllar and Sørensen. 

“We were very encouraged by the impressive number of project proposals from a wide range of areas and are looking forward to introducing several new capacity and community-building activities in the fall,” Sørensen said.. “This wide range of research initiatives will form a vibrant nucleus for Stanford’s growing community of scholars of global development and poverty.”